Antipsychotics for ADHD?

Children with attention and behavior problems are being given medications for schizophrenia and bipolar disorder. Side effects can be serious.

Children are increasingly being prescribed antipsychotic drugs. Prescriptions for antipsychotics rose 62% in the last decade for children aged 3-18 whose families were enrolled in Medicaid.

Much of this increase came from prescriptions for conditions that these drugs are not approved to treat, a practice called off-label prescribing. Approximately 65% of children prescribed antipsychotics in 2007 were receiving them off-label, with many of them apparently receiving it for ADHD; around 50% of the children in the study receiving a prescription for antipsychotics had been diagnosed with ADHD.

The study, performed by researchers at the Children's Hospital of Philadelphia, is the largest of its kind, representing around 35% of the children in the country.

All antipsychotics have serious side effects, including increased risk of weight gain and diabetes in children and stroke in the elderly.

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According to David M. Rubin, a senior author of the study: "If a child is prescribed an antipsychotic, it's important for doctors to inform parents and caregivers if the drug is being prescribed off-label, of potential side effects, and of counseling therapies that might be offered as an alternative to medication."

Antipsychotics are medicines that were originally used to treat symptoms of psychosis, such as delusions or hallucinations. The FDA has approved them for treatment of schizophrenia and bipolar disorder. More recently, certain antipsychotics have also been approved for treatment of depression and autism.

There is some evidence that antipsychotics may be effective at treating a wider range of disorders than they are currently approved to treat. Doctors appear to be prescribing them off-label in the hopes that they may be able to do their patients more good than any approved treatment has been doing for them. A major downside to this practice is that all antipsychotics have serious side effects, including increased risk of weight gain and diabetes in children and stroke in the elderly.

Off-label prescription of antipsychotics isn't limited to children. The Agency for Healthcare Research and Quality (AHRQ), a subsidiary of the Department of Health and Human Services, reports on off-label prescription of antipsychotics. The report was updated in August of 2012.

The AHRQ report and updates detail what is known about the effectiveness of each antipsychotic drug for treating many off-label conditions and also contain other information that may be of interest to patients who have been prescribed an antipsychotic drug off-label or whose doctor has mentioned the possibility of prescribing one.